Health Services Research

SS 44 - HSR 2 - Health Services Research

329 - Cost-Effectiveness of Short Course Radiation Therapy Versus Long-Course Chemoradiation for Locally Advanced Rectal Adenocarcinoma

Wednesday, October 24
4:25 PM - 4:35 PM
Location: Room 008

Cost-Effectiveness of Short Course Radiation Therapy Versus Long-Course Chemoradiation for Locally Advanced Rectal Adenocarcinoma
A. Raldow1, A. B. Chen2, P. Lee1, M. Russell3, T. S. Hong4, D. P. Ryan5, and J. Y. Wo6; 1Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 2Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 3Department of Surgery, University of California Los Angeles, Los Angeles, CA, 4Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, Boston, MA, 5Massachusetts General Hospital, Boston, MA, 6Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA

Purpose/Objective(s): Although long-course chemoradiation (LCRT; 50.4 Gy in 28 fractions with concurrent 5-fluorocuracil based chemotherapy) followed by delayed total mesorectal excision and adjuvant chemotherapy remains the standard of care in the United States for locally advanced rectal adenocarcinoma, many countries follow a protocol of short course radiation therapy (SCRT; 25 Gy in 5 fractions) followed by surgery one week later and subsequent adjuvant chemotherapy. The purpose of this study was to analyze the cost-effectiveness of SCRT versus LCRT for patients with locally advanced rectal cancer.

Materials/Methods: We developed a cost-effectiveness model simulating 10-year outcomes for 65-year-old patients with locally advanced rectal cancer treated with either SCRT or LCRT, both followed by surgery and adjuvant chemotherapy. For the base case analysis, we assumed 3D-conformal radiation treatment. We used utilities and costs based on the literature and Medicare Fee schedules to determine incremental cost-effectiveness ratios of SCRT versus LCRT. We defined cost effectiveness at an incremental cost-effectiveness ratio (ICER) of $100,000/quality-adjusted life-year (QALY) or less. We assumed that SCRT would not result in tumor shrinkage adequate enough to change rates of sphincter preservation, while LCRT would result in higher rates of low anterior resection (LAR). To model preference-sensitive care, we conducted a two-way sensitivity analysis in which we simultaneously varied the utilities of the no evidence of disease states with LAR (NED-LAR) and abdominoperineal resection (APR; NED-APR). To model the current practice of many radiation oncologists, we repeated the analysis assuming 3D-conformal treatment for LCRT but intensity modulated radiation therapy (IMRT) for SCRT.

Results: In the base case analysis, SCRT was the cost-effective strategy as compared to LCRT (ICER of $259,545/QALY). SCRT remained the cost-effective strategy as compared to LCRT when assuming 3D-conformal treatment for LCRT but IMRT for SCRT (ICER of $236,832/QALY). On one-way sensitivity analysis, LCRT became the cost-effective approach when the utility of NED-APR was below 0.47. Two-way sensitivity analysis revealed that the cost-effective approach for a given patient depended on the utilities for the NED-LAR and NED-APR states.

Conclusion: SCRT was the cost-effective strategy as compared to LCRT for patients locally advanced rectal cancer. However, the cost effectiveness of SCRT versus LCRT was sensitive to the utilities associated with the NED-LAR and NED-APR health states, highlighting the importance of patient preference-sensitive care.

Author Disclosure: A. Raldow: None. P. Lee: Honoraria; Viewray. Commitee Co-Chair; Committee Co-Chair. M. Russell: None. T.S. Hong: Research Grant; Novartis, Taiho. J.Y. Wo: None.

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